Lab reviews at lightning speed in the cloud

The Big Picture

US-based Avalon Healthcare Solutions is a laboratory benefit management company that helps payers manage the cost and effective use of diagnostic lab tests.

Avalon turned to Accenture for its deep knowledge of the health industry and alliance with Amazon Web Services (AWS). The Accenture AWS Business Group (AABG) architected and built a 100-percent, cloud-based Claims Editor as a Service (CEaaS), which can edit up to 150,000 claims per hour with 99 percent uptime and 99.5 percent accuracy. The solution uses AWS’s elastic capability to support rapid onboarding of additional health plans and rising claims volume.

CEaaS also has built-in analytics to deliver insights, which is helping Avalon’s clients save by reducing reimbursement for unneeded lab claims.

Client Profile

Headquartered in Tampa, Florida, Avalon Healthcare Solutions develops and deploys policies for complex laboratory environments. The company combines scientific recommendations from its clinical advisory board with information technology solutions to guide delivery of the right lab tests at the right time.

Opportunity

The laboratory industry is exploding with innovation, and the ability to evaluate new advances is critical. Avalon’s area of expertise is assessing laboratory charges for health payers within insurers’ end-to-end process of reviewing all aspects of health claims.

In the United States, more than 8 billion lab tests are performed annually, and as many as 30 percent are deemed overused or unnecessary.
Underutilization of lab tests can also be problematic as it may increase risks and treatment costs in patients with chronic conditions.

Founded in 2013, Avalon sought to accelerate service delivery, choosing Accenture for deep knowledge of the healthcare industry, technology skills and cloud-based solutions.

How we helped

In the initial strategy phase, Accenture helped Avalon executives weigh go-to-market options. Avalon decided to go with a cloud-based platform to avoid an extended timeline and the higher cost of building infrastructure in-house. The AWS cloud has a history of secure operations, which is essential for health providers and payers complying with strict US privacy guidelines.

On behalf of Avalon, AABG architected and built a first-of-its-kind, 100-percent, cloud-based Claims Editor as a Service (CEaaS). Accenture clinicians researched and developed more than 130 laboratory policies for use on the service. The Accenture and Avalon team also developed the detailed business rules and algorithms that enable processing in real time for submitted claims. A portal for providers, patients and health plans provides appropriate access to data, claims and prior authorization.

Results

Accenture AWS Business Group helped Avalon roll out the new cloud-based service, now able to produce results at lightning speed. The service can edit up to 20,000 claims per hour with response time averaging less than a second: 856 milliseconds, to be precise.

The flexible, “future proofed” cloud-based solution can be scaled up as demand grows for Avalon’s services; it can also be easily updated
depending on changing insurer policies, research findings and regulatory guidelines.

The service has a built-in foundation for advanced analytics. Growing volumes of digital data can be mined for statistical analysis, which is critically important as new lab tests and treatments continually emerge. These insights are key to Avalon’s ability to help clients save by minimizing unnecessary lab tests based on findings from clinical research.

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